In my last editorial, I had made a feeble attempt to guide the novice author to write articles for medical and dental journals. Why I describe my effort as feeble is because of several responses from audience tabulating the core issues I had omitted in my discussion and the minimal importance I had emphasized to the enthusiasm and attitude of the authors who come forward to write. I confess to both the lacunae and leave such didactic topics to experts. In this issue, I revert back to my favorite topic, that is, patients and medical care.

All doctors encounter patients once in a while who do not fit into the knowledge window of one single disease. Richard Cabot, the reformist physician and hematologist, used to point out that there is at least one symptom or sign that does not fit in or make sense. My view on this aspect has a different angle. We are exposed to medicine and dentistry mostly from American or British books and such exposure leaves no scope for understanding the health issues of our Indian population, all of whom differ from one another, with individual fears and prejudices, each with a unique set of genes, and extremely varying environmental, ethnic, and cultural backgrounds. Textbooks train our minds to treat cases, but miserably fail in training us to approach a fellow creature in need of help.

The next dilemma the dentist/doctor faces is whether to prescribe a particular test/equipment to assist his/her diagnosis and treatment. My teacher used to repeatedly say that the latest medical equipment are good servants, but bad masters. But, the trend is to use every available equipment because it is available and it has been bought at a considerable cost. I repeat a certain sentence from the Oxford Textbook of Medicine in this context - “Diagnosis is best arrived at by the history and the five senses (of which common sense is still the most important).”

Next comes the million dollar question patients hesitate to ask and sometimes openly ask. “Is the doctor experienced enough to handle my treatment?” (whether it is a simple tooth extraction or an intravenous injection?). My answer to such questions is- “You are not my first patient. But I handle with the care and enthusiasm I showed to my first patient.” As a devil's advocate, the practitioner must conscientiously ask himself/herself, “Am I experienced enough or would I like this procedure done to myself, my wife, or my child?”..... Since the gold standard for experience and skill in medicine and dentistry is still not defined, perhaps this is the only way to judge.

Practice of medicine and dentistry is both an art and a science. Probably, the art occupies a major share in private practice where you have to treat and simultaneously please the patient. In government hospitals and institutional care, the science occupies a major share since the pleasing component is not considered necessary.

For most patients, the interaction with doctors and health-care system can be best described by certain words – dissatisfaction, costly, unsympathetic, laboratory tests and X-rays, fleecing, and unappreciative of the patient as a person. In this context, I quote D. H. Lawrence whose poem clearly depicts what the patient feels.

“When I went to the scientific doctor

I realised what a lust there was in him to wreak

his so-called science on me

and reduce me to the level of a thing.

So I said: Good-morning! and left him.”

The doctors, who have practiced for long, realize that the continual sensational stories of medical breakthroughs are lies at the worst and misleading at the best. D. F. Horrobin attributes this failure to two core issues. First is that medicine is an applied science, a science with purpose. Second is that the claim that we make to the patient that it is scientific is, in fact, not scientific for the most part. The age-old description of medicine as “To cure sometimes, to relieve often, to comfort always” best describes what we must clearly convey to the patients.

Why do I say medicine is not scientific? Most therapies are accidental discoveries, for example, monoamine oxidase inhibitors were started as antituberculosis drugs and were accidentally noted to improve depression. Digitalis was identified when the learned physicians tried to investigate how a congestive heart failure patient suddenly showed improvement when he chewed some leaves given by a tribal lady. Phenothiazines were originally tried for shock management following surgeries, but found to improve psychosis.

Of late, fortunately I would say, the gold standard for any treatment has shifted from science mode to evidence-based approach. The legal system of prima facie or circumstantial evidence seems to speed up the progress of medicine more than pure science. What works best is the right mode and I am sure such pattern identification is likely to expedite the design of dental/medical treatments in the near future. Readers are welcome to share their ideas and contradict/conflict my views at masthankmk@gmail.com.